The institute's Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry nutrition pathology histochemistry chemistry physical, chemical, and molecular biology pharmacology and toxicology.

NIDDK extramural research is organized into four divisions: Diabetes, Endocrinology and Metabolic Diseases; Digestive Diseases and Nutrition; Kidney, Urologic and Hematologic Diseases; and Extramural Activities.

The institute supports basic and clinical research through investigator-initiated grants, program project and center grants, and career development and training awards. The institute also supports research and development projects and large-scale clinical trials through contracts.

November 15, 1950--The National Advisory Arthritis and Metabolic Diseases Council held its first meeting and recommended approval of NIAMD's first grants.

November 22, 1950--NIAMD was established by Surgeon General Scheele.

1959--Dr. Arthur Kornberg, former chief of the institute's enzyme and metabolism section, won the Nobel Prize for synthesizing nucleic acid.

The institute initiated an intramural research program in gastroenterology and launched an intramural research program in cystic fibrosis with the establishment of the Pediatric Metabolism Branch.

1961--Laboratory-equipped, mobile trailer units began an epidemiological study of arthritis among the Blackfeet and Pima Indians in Montana and Arizona, respectively.

October 16, 1969--The Nobel Prize was awarded to Dr. Marshall W. Nirenberg of the National Heart Institute who reported his celebrated partial cracking of the genetic code while an NIAMD scientist (1957-1962).

November 1970--The institute celebrated its 20th anniversary. Leaders in the department, representatives from voluntary health agencies and professional biomedical associations, as well as past and present institute National Advisory Council members, heard an address by Secretary of Defense Melvin R. Laird.

May 19, 1972--The institute name was changed to the National Institute of Arthritis, Metabolism, and Digestive Diseases.

October 1972--Christian B. Anfinsen, chief of the institute's Laboratory of Chemical Biology, shared a Nobel Prize with two other American scientists for his demonstration of one of the most important simplifying concepts of molecular biology, that the three-dimensional conformation of a native protein is determined by the chemistry of its amino acid sequence. A significant part of this research cited by the award was performed while with NIH.

September 1973--The institute's diabetes centers program was initiated with the establishment of the first Diabetes-Endocrinology Research Centers.

November 1975--After 9 months of investigation into the epidemiology and nature of diabetes mellitus and public hearings throughout the U.S., the National Commission on Diabetes delivered its report, the Long-Range Plan to Combat Diabetes, to Congress. Recommendations encompassed expansion and coordination of diabetes and related research programs the creation of a diabetes research and training centers program acceleration of efforts in diabetes health care, education, and control programs and the establishment of a National Diabetes Advisory Board.

April 1976--After a year of study and public hearings, the National Commission on Arthritis and Related Musculoskeletal Diseases issued the Arthritis Plan--its report to Congress which called for increasing current arthritis research and training programs conducted by NIH the creation of multipurpose arthritis centers throughout the country the initiation of epidemiologic studies and data systems in arthritis a National Arthritis Information Service and establishment of a National Arthritis Advisory Board.

October 1976--The National Diabetes Advisory Board was established to review and evaluate the long-range plan recommended by the National Commission on Diabetes.

The National Arthritis Advisory Board was established to review and evaluate the Arthritis Plan--formulated by the National Commission on Arthritis and Related Musculoskeletal Diseases.

Dr. Baruch Blumberg was awarded the Nobel Prize in Physiology or Medicine for research on the hepatitis B virus protein--the "Australia antigen"--which he discovered in 1963 while at the institute. This advance has proven to be a scientific and clinical landmark in detection and control of viral hepatitis and led to the development of preventive measures against hepatitis and liver cancer.

April 19, 1977--The director, NIH, established a trans-NIH program for diabetes, with lead responsibility in NIAMDD.

September 1977--Over $5 million in grants was awarded to five institutions to establish Diabetes Research and Training Centers.

October 1977--In response to the recommendation of the National Commission on Diabetes, the National Diabetes Data Group was established within the institute to collect, analyze, and disseminate data on this disorder to scientific and public health policy and planning associations.

December 1977--Three scientists won the Nobel Prize for work supported partly by NIAMDD grants. Drs. Roger C. L. Guillemin and Andrew V. Schally were recognized for discoveries concerning peptide hormone production in the brain, and Dr. Rosalyn S. Yalow shared the prize for her work in the development of radioimmunoassays of peptide hormones.

December 1978--A study of cystic fibrosis focused on the need for future research activities, including increased support for clinical and basic research, expansion of specialized CF research resources, emphasis on training of scientific personnel, and coordination of public and private cystic fibrosis research activities. Prepared by the Cystic Fibrosis Foundation, Cystic Fibrosis--State of the Art and Directions for Future Research Efforts, was commissioned by the NIAMDD and the National Heart, Lung, and Blood Institute.

January 1979--Following 2 years of study and public hearings, the National Commission on Digestive Diseases issued its report, The National Long-Range Plan To Combat Digestive Diseases. Recommendations to Congress included the establishment of a National Digestive Diseases Advisory Board, an information clearinghouse, and increased emphasis on educational programs in digestive diseases in medical schools.

November 1979--Dr. Jesse Roth, chief of the Diabetes Branch of NIAMDD intramural research, was named the first winner of the Lita Annenberg Hazen Award for achievement in medical research and teaching.

December 1979--A task force completed its study and submitted the report, An Evaluation of Research Needs in Endocrinology and Metabolic Diseases.

September 1980--Dr. Joseph E. Rall, director of NIAMDD intramural research, became the first person at NIH to be named to the distinguished executive rank in the Senior Executive Service. The award was presented by President Carter in ceremonies at the White House on September 9.

October 15, 1980--NIAMDD celebrated its 30th anniversary with a symposium, "DNA, the Cell Nucleus, and Genetic Disease," and a dinner at the National Naval Medical Center. Dr. Donald W. Seldin, chairman of the department of internal medicine, University of Texas Southwestern Medical School, Dallas, was guest speaker.

June 23, 1981--The institute was renamed National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases.

April 1982--HHS Secretary Richard S. Schweiker elevated NIADDK's program clusters to division status, creating five extramural divisions and the Division of Intramural Research.

November 1982--Dr. Elizabeth Neufeld received a Lasker Foundation Award. She is cited, along with Dr. Roscoe E. Brady of NINCDS, for "significant and unique contributions to the fundamental understanding and diagnosis of a group of inherited diseases called mucopolysaccharide storage disorders (MPS)."

November 1984--Grants totaling more than $4 million were awarded to six institutions to establish Silvio O. Conte Digestive Disease Research Centers. The research centers investigate the underlying causes, diagnoses, treatments, and prevention of digestive diseases.

April 8, 1986--The institute's Division of Arthritis, Musculoskeletal and Skin Diseases became the core of the new National Institute of Arthritis and Musculoskeletal and Skin Diseases. The NIADDK was renamed the National Institute of Diabetes and Digestive and Kidney Diseases.

June 3, 1986--The National Kidney and Urologic Diseases Advisory Board was established to formulate the long-range plan to combat kidney and urologic diseases.

August 1, 1987--Six institutions were funded to establish the George M. O'Brien Kidney and Urological Research Centers. The research centers study diseases of the kidney and urinary tract, which are among the Nation's most critical health problems.

December 25, 1987--In response to congressional language on the FY 1988 appropriation for the NIDDK, the institute established a program of cystic fibrosis research centers.

September 16, 1990--NIDDK celebrated its 40th anniversary. Dr. Daniel E. Koshland, Jr., editor of Science, was guest speaker.

September 30, 1992--Three Obesity/Nutrition Research Centers and an animal models core to breed genetically obese rats for obesity and diabetes research were established.

October 12, 1992--Drs. Edwin G. Krebs and Edmond H. Fischer were awarded the Nobel Prize in Physiology or Medicine for their work on "reversible protein phosphorylation." They have received grant support from NIDDK since 1955 and 1956, respectively.

October 30, 1992--In response to congressional language on the institute's FY 1993 appropriation, the NIDDK initiated a program to establish gene therapy research centers with emphasis on cystic fibrosis.

November 1, 1993--The functions of the NIH Division of Nutrition Research Coordination, including those of the NIH Nutrition Coordinating Committee, were transferred to NIDDK.

August 15, 1950--Public Law 81-692, the Omnibus Medical Research Act, authorized establishment of NIAMDD to "... conduct researches relating to the cause, prevention, and methods of diagnosis and treatment of arthritis and rheumatism and other metabolic diseases, to assist and foster such researches and other activities by public and private agencies, and promote the coordination of all such researches, and to provide training in matters relating to such diseases... ." Section 431 also authorized the Surgeon General to establish a national advisory council.

May 19, 1972--President Nixon signed P.L. 92-305 to bring renewed emphasis to research in digestive diseases by changing the name of the institute to the National Institute of Arthritis, Metabolism, and Digestive Diseases (NIAMDD) and by designating a digestive diseases committee within the institute's National Advisory Council.

July 23, 1974--Public Law 93-354, the National Diabetes Mellitus Research and Education Act, was signed. The National Commission on Diabetes, called for by this act, was chartered on September 17, 1974, members were appointed by the HEW secretary. The act called for centers for research and training in diabetes and establishment of an intergovernmental diabetes coordinating committee, including NIAMDD and six other NIH institutes.

January 1975--The National Arthritis Act of 1974 (P.L. 93-640) was signed into law to further research, education and training in the field of the connective tissue diseases. The mandated National Commission on Arthritis and Related Musculoskeletal Diseases, was appointed by the HEW secretary June 2. The act required centers for research and training in arthritis and rheumatic diseases and the establishment of a data bank, as well as an overall plan to investigate the epidemiology, etiology, control and prevention of these disorders.

October 1976--P.L. 94-562, the Arthritis, Diabetes, and Digestive Diseases Amendments of 1976, established the National Diabetes Advisory Board charged with advising the Congress and the HEW secretary on implementation of the "Long-Range Plan to Combat Diabetes" developed by the National Commission on Diabetes. The law also established the National Commission on Digestive Diseases to deal with many problems, including investigation into the incidence, duration, mortality rates, and social and economic impact of digestive diseases.

The National Arthritis Advisory Board, established by the same law, reviews and evaluates the implementation of the Arthritis Plan, formulated by the Arthritis Act of 1974. The board advises Congress, the HHS secretary, and heads of Federal agencies with respect to the plan and other Federal programs relating to arthritis.

December 1980--Title II of the Health Programs Extension Act of 1980, P.L. 96-538, changed the institute's name to the National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases. The act also established the National Digestive Diseases Advisory Board. The law authorized the National Diabetes Information Clearinghouse, the Diabetes Data Group, and the National Digestive Diseases Information and Education Clearinghouse. In addition, it reauthorized advisory boards for arthritis and diabetes research.

December 5, 1980--The Omnibus Reconciliation Act of 1980 (P.L. 96-499) directed the Secretary to carry out a demonstration project to determine whether nutritional therapy can retard the progression of early renal disease and thus delay the onset of dialysis.

November 20, 1985--The Health Research Extension Act of 1985, P.L. 99-158, changed the institute's name to the National Institute of Diabetes and Digestive and Kidney Diseases. The act also established the National Kidney and Urologic Diseases Advisory Board. The law gave parallel special authorities to all of the institute's operating divisions, including authorization of the National Kidney and Urologic Diseases Information Clearinghouse; the National Kidney, Urologic, and Hematologic Diseases Coordinating Committee; the National Kidney and Urologic Diseases Data System; the National Digestive Diseases Data System; kidney and urologic diseases research centers and digestive diseases research centers.

November 4, 1988--The Health Omnibus Programs Extension Act of 1988 (P.L. 100-607) gave permanent authority to the NIDDK Advisory Boards by deleting their date of expiration.

June 10, 1993--The NIH Revitalization Act of 1993, P.L. 103-43, established NIDDK as the lead institute in nutritional disorders and obesity, including the formation of a research and training centers program on nutrtional disorders and obesity.

Born December 22, 1934, in Baldwyn, Miss., Dr. Gorden received his B.A. from Vanderbilt University in 1957 and his M.D. from Vanderbilt University School of Medicine in 1961. He completed his internship and residency at Yale University and began his research career as a PHS clinical fellow and research fellow in metabolism there in 1964.

He joined NIDDK in 1966 as senior investigator in the Clinical Endocrinology Branch, and, in 1974, he became senior investigator in the Diabetes Branch. From 1976 to 1978, he was a visiting professor at the Institute of Histology and Embryology at the University of Geneva School of Medicine in Switzerland. From 1974 to 1976 and from 1980 to 1986, he served as institute clinical director.

In 1983 Dr. Gorden was appointed chief of the Diabetes Branch. He has held the position of chief, section on clinical and cellular biology of the Diabetes Branch since 1978. For several years, Dr. Gorden has held appointments as clinical professor of medicine, Uniformed Services Medical School in Bethesda, Md., and clinical associate professor, Howard University School of Medicine, Washington, D.C.

He was appointed director, NIDDK, on September 5, 1986, to succeed Dr. Lipsett. He was sworn in as an assistant surgeon general (rear admiral) of the USPHS on June 15, 1989.

An internationally recognized expert in diabetes, endocrinology, and metabolism, Dr. Gorden's research interests include disorders of insulin secretion, heterogeneity of circulating polypeptide hormones, hypoglycemic states, and disorders of growth hormone secretion. In collaboration with leading scientists in the diabetes field, he has extensively studied insulin-resistant states in man, especially those characterized by disorders of the insulin receptor, and has pioneered work on receptor mediated endocytosis of polypeptide hormones.

He is the author of more than 250 scientific papers and has received many honors and awards for his work. In 1986 he was presented an honorary doctorate by the University of Geneva in Switzerland for collaborative research relating to diabetes and the mechanisms of insulin action, which has been conducted with the university over the past 10 years. Also in 1986, he was awarded the PHS Distinguished Service Medal.

In 1988 Dr. Gorden received the PHS Commendation Medal. In 1990 he received the Distinguished Alumnus Award and Medal from Vanderbilt University School of Medicine in Nashville, Tenn. He was honored "for his high achievement through outstanding leadership and contributions to the profession as distinguished physician, clinical scientist, and progressive leader supporting the profession and reflecting high honor on his alma mater through his actions as physician, researcher, alumnus director at NIH and national and international contributor to the profession of medicine."

He received the Instituto Rotariano per l'Italia Meridonale Award of the Rotary International in Naples, Italy, and the Public Information Award of the Juvenile Diabetes Foundation International in 1992. In 1993 he received the National Scientific Leadership Award of the Crohn's and Colitis Foun-dation of America, and the PHS Surgeon General's Exemplary Service Medal.

Fiscal Year	Total Grants $	Direct Operations $	Total $
1954	3,621	3,379	7,000
1955	4,390	3,880	8,270
1956	5,910	4,930	10,840
1957	10,290	5,595	15,885
1958	13,837	6,548	20,385
1959	23,421	7,794	31,215
1960	38,553	8,309	46,862
1961	50,882	10,318	61,200
1962	69,809	12,022	81,831
1963	90,011	13,377	103,388
1964	99,914	13,765	113,679
1965	97,905	15,145	113,050
1966	104,393	18,810	123,203
1967	113,621	22,066	135,687
1968	116,160	22,738	138,898
1969	117,953	25,934	143,887
1970	118,959	27,660	146,619
1971	109,670	28,669	138,339
1972	122,309	31,016	153,325
1973	134,522	32,794	167,316
1974	125,622	33,825	159,447
1975	136,011	37,503	173,514
1976	138,612	40,904	179,516
1977	170,944	48,656	219,600
1978	202,719	57,534	260,253
1979	238,199	64,568	302,767
1980	274,088	67,118	341,206
1981	300,943	68,519	369,462
1982	296,898	71,293	368,191
1983	335,566	77,926	413,492
1984	384,080	79,946	464,026
1985	453,458	86,041	539,499
1986	461,890	85,483	547,373
1987	425,062	85,818	510,880
1988	442,618	91,741	534,359
1989	462,697	96,617	559,274
1990	474,455	105,529	579,984
1991	500,127	115,135	615,262
1992	539,913	121,533	661,446
1993	553,838	126,676	680,514
1994
1995

NIDDK Programs

Division of Intramural Research

The Division of Intramural Research conducts research and training within the institutein 1993s laboratories and clinical facilities in Bethesda, Md., and at the Phoenix Epidemiology and Clinical Research Branch in Arizona.

The division has 10 branches and 12 laboratories, which cover a wide range of research areas. In addition, there is a section on veterinary sciences, a joint program between the NIDDK and the Cystic Fibrosis Foundation to do basic research and an institute-wide research training program in nutrition.

Eight branches are engaged primarily in basic and clinical research on diabetes, bone metabolism, endocrinology, hematology, digestive diseases, and genetics. The Phoenix Epidemiology and Clinical Research Branch develops and applies epidemiologic and biologic methods in field studies throughout the world on selected populations at risk of developing specific diseases, especially diabetes and its complications. The 10th branch addresses mathematical modeling of biological problems.

The laboratories are engaged in fundamental research related to the institute's mission (e.g., molecular biology, chemistry, mathematics, cell biology, toxicology, pharmacology, physics, biochemistry, neuroscience, and developmental biology). The laboratory animal science section provides research animal support and collaboration to the research programs of the institute.

Division of Diabetes, Endocrinology and Metabolic Diseases

The DEMD supports research and research training related to diabetes mellitus, endocrinology, and metabolic diseases including cystic fibrosis. In addition, DEMD leads the administration of the Trans-NIH Diabetes Program and coordinates federally supported diabetes-related activities. The division also administers the Trans-NIH Cystic Fibrosis Program.

Diabetes Programs Branch

Diabetes Research Program. This program supports basic and clinical studies related to the etiology, pathogenesis, prevention, diagnosis, treatment, and cure of diabetes mellitus and its complications. The program also supports investigations related to pancreas and islet transplantation, automated insulin delivery systems, glucose sensors, the epidemiology of diabetes and its complications, and behavioral research related to diabetes.

Diabetes Centers Program. Two types of awards are made: Diabetes/Endocrinology Research Centers, exclusively oriented toward biomedical research goals, and the Diabetes Research and Training Centers (DRTC), which include training and information transfer components in addition to research. The DERCs and DRTCs integrate, coordinate, and foster interdisciplinary cooperation of investigators in diabetes and related endocrine and metabolic disorders. Both programs also provide limited funds for pilot and feasibility studies to encourage young investigators and new initiatives.

Clinical Trials Program. This program supports a multicenter randomized clinical trials on the treatment and prevention of insulin-dependent and noninsulin-dependent diabetes mellitus.

National Diabetes Data Group . The NDDG serves as the major Federal focus for the collection, analysis, and dissemination of data on diabetes and its complications.

WHO Collaborating Center for Diabetes. This center, sponsored by the Division of Diabetes, Endocrinology, and Metabolic Diseases, solicits and provides guidance in developing international research about diabetes through NIH research grants and contracts; promotes interchange of scientific and health information among WHO member countries; and provides expert advice and consultation to WHO and other international committees and agencies.

Endocrinology and Metabolic Diseases Programs Branch

Endocrinology Research Program. Basic and clinical studies of normal and abnormal functions of the pituitary, thyroid, parathyroid, and adrenal glands, as well as other components of the endocrine system are supported. Studies involve the mode of action of hormones, their biosynthesis, secretion, and metabolism as well as their binding to protein carriers, and interactions with other hormones and metabolites.

Hormone Distribution Program. This program makes available to the research community human and animal pituitary hormones, antisera against the hormones, and selected other hormonal and biological products. An important research resource for the scientific community, this program gives scientists access to hormones and antisera of known composition and potency, most of which are unavailable commercially.

Metabolic Diseases Research Program. This program funds investigator-initiated research into enzymatic mechanisms, biological transport, and membrane structure as they relate to the etiology, pathogenesis, and treatment for acquired or inborn errors of metabolism.

Cystic Fibrosis Research Program. This program supports investigator-initiated research and research center grants related to the genetic, metabolic, and nutritional aspects of CF and its complications.

Division of Digestive Diseases and Nutrition

This division supports research related to liver and biliary diseases, pancreatic diseases, gastrointestinal diseases, including neuroendocrinology, motility, immunology, and digestion in the GI tract, nutrient metabolism, obesity, eating disorders, and energy regulation. The division provides leadership in coordinating activities related to digestive diseases and nutrition throughout the NIH and with various other Federal agencies.

Digestive Diseases Branch

Liver and Biliary Program. This program supports basic and clinical research into the normal function and the diseases of the liver and biliary tract. Areas of study include hepatic regeneration liver cell injury, fibrosis, and death basic and applied studies on liver transplantation metabolism of bile acids and bilirubin physiology of bile formation factors controlling cholesterol levels in bile gallbladder and bile duct function cholesterol and pigment gallstones inborn errors in bile acid metabolism chronic hepatitis that evolves from autoimmune, viral, or alcoholic disease and other liver diseases.

Pancreas Program. This program encourages research into the structure, function, and diseases (excluding cancer and cystic fibrosis) of the exocrine pancreas. Research efforts focus on hormonal and neural regulation of electrolyte, fluid, and enzyme secretion receptors for secretagogues stimulus-secretion coupling mechanisms gut-islet-acinar interrelations organization and expression of pancreatic genes protein synthesis and export tissue injury, repair, and regeneration physiology and pathology of trophic responses neural innervation transcapillary solute and fluid exchange pancreatic transplantation, storage, and preservation imaging of the pancreas pancreatic insufficiency acute and chronic pancreatitis and relevant experimental models and endocrine tumors.

Gastrointestinal Neuroendocrinology Program. This program supports both basic and clinical studies on normal and abnormal function of the enteric nervous system and the central nervous system elements that control the enteric nervous system. Research focuses on gastrointestinal hormones and peptides and studies on disease conditions associated with excessive or deficient secretions of neuropeptides.

Gastrointestinal Digestion Program. This program supports research on the process of food digestion in the gastrointestinal tract (GIT). Areas of research focus on the regulation of gene expression in the developing gastrointestinal tract the structure and function of the gut mucosa the cytoskeletal structure and contractility in brush border the growth and differentiation of gastrointestinal cells in normal and disease states intestinal transplantation, storage, and preservation and gastrointestinal tissue injury, repair, and regeneration.

Also supported are studies on gastrointestinal diseases such as maldigestion and malabsorption syndromes, celiac sprue, diarrhea, inflammatory bowel disease, gastric and duodenal ulcers, diseases of the salivary glands (excluding cystic fibrosis), and the effects of prostaglandins and other treatment modalities on the gastrointestinal tract and their possible role in the pathogenesis and treatment of digestive diseases.

Gastrointestinal Motility Program. This program supports research on the structure and function of gastrointestinal muscles, the biochemistry of contractile processes and mechanochemical energy conversion relations between metabolism and contractility in smooth muscle, extrinsic control of digestive tract motility, and the fluid mechanics of gastrointestinal flow. Areas of interest include the actions of drugs on gastrointestinal motility, intestinal obstruction, and diseases such as irritable bowel syndrome, colonic diverticular disease, swallowing disorders, and gastroesophageal reflux.

Gastrointestinal, Mucosal and Immunology Program. The research emphasis of this program focuses on intestinal immunity and inflammation. Areas of interest include: ontogeny and differentiation of gut-associated lymphoid tissue migratory pathways of intestinal lymphoid cells humoral antibody responses cell-mediated cytotoxic reactions and the role of cytotoxic effector cells in chronic intestinal inflammation genetic control of the immune response at mucosal surfaces immune response to enteric antigens in both intestinal extraintestinal sites granulomatous inflammation lymphokines and cellular immune regulation leukotrienes/prostaglandin effects on intestinal immune responses T-cell mediated intestinal tissue injury the intestinal mast cell and its role in intestinal inflammation approaches to optimal mucosal immunoprophylaxis, including viral, bacterial, and parasitic diseases and diseases such as gluten sensitive enteropathy, inflammatory bowel disease, and gastritis.

Acquired Immunodeficiency Syndrome Program. This program encourages research into the characterization of intestinal injury, mechanism of maldigestion, and intestinal mucosal functions, as well as hepatic and biliary dysfunction in AIDS. In addition, studies are supported on mechanisms of nutrient dysfunction, nutritional management in the wasting syndrome and other aspects of malnutrition related to AIDS.

Digestive Diseases Centers Program. This program currently administers research core center grant awards. These awards provide a mechanism for integrating, coordinating, and fostering interdisciplinary cooperation between groups of established investigators who conduct programs of high-quality research that relate to a common theme in digestive disease research.

Clinical Trials Program. This program includes all prospective studies in digestive diseases and nutrition. Using 10 or more patients, studies compare two forms of treatment, one of which could be placebo or "standard" care.

Nutritional Sciences Branch

Nutrient Metabolism Program. This program supports basic and clinical studies related to the requirement, bioavailability, and metabolismof nutrients and other dietary components. Specific areas of research interest include the understanding of the physiological function and mechanism of action/interaction of nutrients within the body the effects of environment, heredity, stress, drug use, toxicants, and physical activity on problems of nutrient imbalance and nutrient requirements in health and disease and specific metabolic considerations relating to alternative forms of nutrient delivery and use such as total parenteral nutrition.

The program also supports research to improve methods of assessing nutritional status in health and disease.

Obesity, Eating Disorders, and Energy Regulation Program. This program funds research on the biomedical and behavioral aspects of obesity, anorexia nervosa, bulimia, and other eating disorders.

The goals of such research are to establish a clear understanding of the etiology, prevention, and treatment of these multifaceted conditions. Areas of research interest focus on the factors that affect food choices, food intake, eating behavior, appetite, and satiety the effects of taste, smell, and gastric and humoral (including neurotransmitters) responses associated with dietary intake and subsequent behavior the physiological and metabolic consequences of weight loss or weight gain the effect of mild exercise on appetite and weight control and the individual variability in energy utilization and thermogenesis.

The program encourages investigations on the dietary determinants of the growth and control of adipocyte size and number the responsiveness of the adipocyte to various metabolic and pharmacologic stimuli the prevention of obesity and other eating disorders improved methods of assessing body composition examination of health risk factors associated with specific degrees of obesity or body composition and determining the effect of exercise on body composition. The program supports an obesity research core center, which serves as a resource for scientists studying various aspects of obesity.

Clinical Nutrition Research Units. The CNRU is an integrated array of research, educational, and service activities focused on human nutrition in health and disease. It serves as the focal point for an interdisciplinary approach to clinical nutrition research and for the stimulation of research in improved nutritional support of acutely and chronically ill persons, assessment of nutritional status, effects of disease states on nutrient needs, and effects of changes in nutritional status on disease.

Obesity/Nutrition Research Centers. The ONRCs encourage collaboration among researchers and a multidisciplinary approach to the treatment and prevention of obesity. They will help to capitalize on emerging research opportunities in obesity and to enhance the translation of research findings to the public.

U.S.-Japan Malnutrition Panel. In 1965 President Lyndon B. Johnson and Japanese Prime Minister Eisaku Sato issued a joint communique recognizing their mutual concern for the health and well-being of all the peoples of Asia. This effort led to the foundation of the U.S.-Japan Cooperative Medical Science Program, which operates within a bilateral government framework. The malnutrition panel was established in 1966 to foster and support investigator-initiated research to help alleviate the serious problem of malnutrition.

Current topics of importance to both the U.S. and Japan focus on consequences of changing dietary patterns on health, development of disease, and disease prevention. Specific research areas addressing these topics include the nutritional significance of varying the polyunsaturated fatty acids in the diet, nutritional aspects of bone disease, endogenous mediators of nutritional metabolism, and improved methodologies applicable to nutritional assessment.

Special Programs Branch

Epidemiology and Digestive Diseases Data System. P.L. 99-158 authorized the establishment of this program for the collection, storage, analysis, retrieval, and dissemination of data derived from patient populations with digestive diseases and, where possible, data involving general populations to detect individuals with a risk of developing digestive diseases.

Liver Transplantation Database Project. The purpose of the 7-year project is to establish a liver transplantation database with data gathered from patients and donors from several transplant centers in the United States. To answer questions about transplantation, data are being collected from patients who are undergoing liver transplantation for various acute and chronic liver diseases and malignancies. The data relate to patients' conditions prior to operation, and in early and late postoperative periods, and to donor livers and malignancies. The data will be evaluated and made available to investigators and clinicians.

Division of Kidney, Urologic and Hematologic Diseases

The division supports research on the physiology, pathophysiology, and diseases of the kidney, genitourinary tract, and the blood and blood-forming organs to improve or develop preventive, diagnostic, and treatment methods.

Kidney Research

Chronic Renal Diseases Program. This program supports basic and clinical studies related to the etiology, pathogenesis, prevention, diagnosis, and treatment of renal diseases that affect adults and children.

Areas of research focus on the primary and nonprimary glomerulopathies and renal disease resulting from various systemic diseases kidney disease of diabetes mellitus kidney disease of hypertension congenital and inherited renal diseases immune-related renal disease IgA nephropathy and tubulointerstitial nephritis.

End-Stage Renal Disease Program. This program focuses on the causes and physiology of uremia, and on hemo-dialysis, peritoneal dialysis, and renal transplantation. The program seeks to improve organ availability by supporting research on transplants across the ABO blood barrier, better cross-matching of donors with recipients, and innovative approaches to making organs available in all areas of the country.

Pediatric Nephrology Program. This program supports basic and clinical research on the causes, treatments, and prevention of kidney diseases of children. Research efforts focus on inherited and congenital renal diseases kidney disease of diabetes mellitus IgA nephropathy and kidney disease and hypertension, which starts in early childhood.

Renal Physiology/Cell Biology Program. This program supports research on the normal structure and function of the kidney including its biochemistry, metabolism, transport, and fluid-electrolyte dynamics. Research is targeted toward the metabolic and physiologic transport processes that regulate solute and water excretion, as are studies on the adverse effects of drugs, nephrotoxins, and environmental toxins in the kidney.

Applying molecular and cellular techniques, the structure of genes and their regulations, growth factors and their signal transduction systems, transport and their genes are studied

The program also has an interest in studies on analgesic abuse and heavy metal nephropathy, as well as studies on certain causes of acute renal failure such as hypoxic renal cell injury.

Urology Research

Urology Program. This program supports basic and clinical research studies of the normal and abnormal development, structure, and function of the genitourinary tract and the affect of diseases and disorders such as diabetes mellitus, spinal cord injury, and multiple sclerosis on these organs.

An area of emphasis is research that will increase the knowledge of the etiology, diagnosis, pathophysiology, therapy, and prevention of the major pediatric and adult urological diseases and disorders.

Also emphasized is basic research and clinical applications of diagnostic and therapeutic modalities such as 1) shock-wave and laser lithotripsy, 2) urolithiasis inhibitors, 3) bladder substitution procedures and devices, and 4) prostate growth inhibitor and reduction therapies.

Women's Health Program. This program encourages and supports basic and clinical research on urological problems that disproportionately affect women. Areas include urinary incontinence, urinary tract infections, and interstitial cystitis.

Division-wide Research

HIV Program. The HIV program supports basic and clinical studies on renal and genitourinary tract structure and function and hematopoietic function in individuals with HIV infection. Studies on HIV infection focus on the effect of HIV therapies on marrow function and clinical course of dialysis and transplant patients, potential interactions of HIV infection and the immunosuppressive therapy used to prevent transplant rejection and effect on organ function.

Centers Program. The George M. O'Brien Kidney and Urologic Research Centers conduct interdisciplinary investigations that address the basic, clinical, and applied aspects of biomedical research in renal and genitourinary physiology and pathophysiology, nephrology, and urology.

The goal of the centers is to reduce mortality and morbidity of kidney and urologic diseases by providing a focus and means for clinical and basic science disciplines to develop the knowledge needed to improve diagnosis, treatment, and prevention.

Clinical Trials Program. This program develops cooperative clinical trials to prevent major chronic kidney, genitourinary, and hematologic diseases.

Epidemiology Program.This program supports the development of epidemiologic data and research related to major kidney, genitourinary, and hematologic diseases. Coordinated under this program are the U.S. Renal Data System the kidney and urologic disease interview and examination component of the third National Health and Nutrition Examination Survey, 1988-94 and management of the epidemiology grants portfolio.

Hematology Research

Hematology Program. This program supports basic and clinical studies of normal and disease states of the hematopoietic system, including sickle cell anemia, thalassemia, aplastic anemia, iron deficiency anemia, thrombocytopenia, hemolytic anemia, and purpura. Areas of interest include morphologic, physiologic, and biochemical aspects of the formation, mobilization, and release of blood cells erythrocyte metabolism and physiology, globin synthesis, ion transport, and enzymatic pathways iron metabolism and absorption erythropoietin and other hematopoietic growth factors hemoglobin metabolism, structure, function, and genetic control porphyrins and prophyrias and metabolism and function of white blood cells and plasma serum proteins.

Office of the Director Advisory Boards

National Diabetes Advisory Board.The NDAB was established to review and evaluate the progress of the long-range plan to combat diabetes designed to accelerate research and to expand programs in diabetes control, health care, and education. The board is composed of members representing a variety of scientific, educational, health care, and public service disciplines. The board provides advice and recommendations to the Congress, the secretary of Health and Human Services, the directors of the NIDDK and the NIH, and the heads of other appropriate Federal agencies and maintains liaison with governmental and nongovernmental entities concerned with diabetes.

National Kidney and Urologic Diseases Advisory Board.The NKUDAB was established to formulate a long-range plan to combat kidney and urologic diseases. The plan has been designed to develop national programs in kidney and urologic diseases research, control, health care, and education. The board is composed of members representing a variety of scientific, educational, health care, and public service disciplines.

The board reviews and evaluates the implementation of the plan provides advice and recommendations to the Congress, the secretary of HHS, the directors of the NIDDK and the NIH, and heads of other appropriate Federal agencies and maintains liaison with governmental and nongovernmental entities concerned with kidney and urologic diseases research and control.

National Digestive Diseases Advisory Board.The NDDAB is authorized to review and evaluate the research, training, prevention, and control programs within the area of digestive diseases. The board is composed of members representing a variety of scientific, educational, health care, and public service disciplines.

The primary function of the board is to review and evaluate progress of the long-range plan developed for digestive diseases update the plan to assure its continuing relevance provide advice and recommendations on plan implementation to the Congress, the secretary of HHS, the directors of the NIDDK and the NIH, and the heads of other Federal agencies and maintain liaison with advisory bodies of other Federal agencies involved in implementing the plan.

Information Clearinghouses

National Kidney and Urologic Diseases Information Clearinghouse. The clearinghouse serves as an information resource for professional and patient education in kidney and urologic diseases through direct response and referral. The clearinghouse collects patient and professional educational materials for the NKUDIC subfile of the Combined Health Information Database and works with educators and health professionals to develop and exchange educational material.

National Digestive Diseases Information Clearinghouse. The clearinghouse is a central point for the collection and dissemination of information and education materials about digestive diseases. The clearinghouse works closely with local and national digestive disease organizations, and professional groups, in developing fact sheets and establishing priority areas of disease information emphasis through the strategic long-range plan. The overall goal of the NDDIC is to increase knowledge and understanding about digestive diseases among patients, health professionals, and the public through the effective dissemination of information.

National Diabetes Information Clearinghouse. The NDIC functions as the central point for the collection and dissemination of information about educational materials, programs, and resources relevant to diabetes. The clearinghouse works closely with the Diabetes Research and Training Centers, local and national diabetes organizations, professional groups, state departments of health, and other Federal and state agencies. The overall goals of the NDIC are to increase knowledge and understanding about diabetes among patients, health professionals, and the public through the effective dissemination of information, and to function as a catalyst in assisting and enhancing the efforts of these various groups in the development and exchange of educational materials and diabetes information.